Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0737, USA.
University of California, San Diego Moores Cancer Center, San Diego, CA, USA.
Support Care Cancer. 2022 Apr;30(4):3187-3200. doi: 10.1007/s00520-021-06743-3. Epub 2021 Dec 26.
To examine long-term cognitive effects of chemotherapy and identify predictors among women with breast cancer (WBC).
Sixty-nine WBC scheduled to receive chemotherapy, and 64 matched-controls with no cancer, participated. Objective and subjective cognition, total sleep time, nap time, circadian activity rhythms (CAR), sleep quality, fatigue, and depression were measured pre-chemotherapy (Baseline), end of cycle 4 (Cycle-4), and one-year post-chemotherapy (1-Year).
WBC showed no change in objective cognitive measures from Baseline to Cycle-4 but significantly improved from both time points to 1-Year. Matched-controls showed an increase in test performance at all time points. WBC had significantly higher self-reported cognitive dysfunction at Cycle-4 and 1-Year compared to baseline and compared to matched-controls. Worse neuropsychological functioning was predicted by less robust CARs (i.e., inconsistent 24 h pattern), worse sleep quality, longer naps, and worse cognitive complaints. Worse subjective cognition was predicted by lower sleep quality and higher fatigue and depressed mood.
Objective testing showed increases in performance scores from pre- and post-chemotherapy to one year later in WBC, but matched-controls showed an increase in test performance from baseline to Cycle-4 and from Cycle-4 to 1-Year, likely due to a practice effect. The fact that WBC showed no practice effects may reflect a form of learning deficit. Compared with the matched-controls, WBC reported significant worsened cognitive function. In WBC, worse objective and subjective cognitive functioning were predicted by worse sleep and sleep-related behaviors (naps and CAR). Interventions that target sleep, circadian rhythms, and fatigue may benefit cognitive function in WBC.
研究化疗对乳腺癌患者（WBC）长期认知功能的影响，并确定预测因素。
共有 69 名计划接受化疗的 WBC 和 64 名无癌症的匹配对照者参与了该研究。在化疗前（基线）、第 4 周期末（第 4 周期）和化疗后 1 年（1 年），对患者的客观和主观认知、总睡眠时间、小睡时间、昼夜活动节律（CAR）、睡眠质量、疲劳和抑郁进行了测量。
WBC 的客观认知测试在基线到第 4 周期之间没有变化，但在这两个时间点到 1 年时都有显著改善。匹配对照组在所有时间点的测试表现都有所提高。WBC 在第 4 周期和 1 年时自我报告的认知功能障碍明显高于基线和匹配对照组。认知功能障碍更严重的预测因素包括 CAR 不稳健（即，24 小时模式不一致）、睡眠质量差、小睡时间长和认知症状更严重。较差的主观认知功能与较差的睡眠质量、更高的疲劳和抑郁情绪有关。
客观测试显示，WBC 的认知功能在化疗前和化疗后一年的测试中都有所提高，但匹配对照组在基线到第 4 周期和第 4 周期到 1 年的测试中都有所提高，这可能是由于练习效应。WBC 没有表现出练习效应，这可能反映了一种学习缺陷。与匹配对照组相比，WBC 报告的认知功能明显下降。在 WBC 中，较差的客观和主观认知功能与较差的睡眠和睡眠相关行为（小睡和 CAR）有关。针对睡眠、昼夜节律和疲劳的干预措施可能有助于改善 WBC 的认知功能。
